Urology Residency Training ProgramGlickman Urological & Kidney Institute

We welcome your interest in the Cleveland Clinic Glickman Urological & Kidney Institute’s Urology Residency Training Program. Ours is a six-year program integrating one year of pre-specialty training, one year of research and four years of clinical urology training. This brochure provides an overview of our program as well as information about living in the Cleveland area.

All institute members are committed to maintaining an academic environment that fosters the best possible graduate urologic training. Our residency training program offers a variety of challenging clinical experi-ences as well as numerous opportunities for basic and clinical research. The Glickman Urological & Kidney Institute’s collegial atmosphere and ample support staff enable residents to balance clinical and investigative training with family and personal interests outside the hospital.

Urology is a rapidly advancing specialty, and the Glickman Urological & Kidney Institute is at the forefront of progress, with strong programs in all of the subspecialty areas. We believe that our residency program is among the best and that it will enable our graduates to take their place among tomorrow’s leaders in clinical and investigative urology.

Sincerely,

Dear Medical Students,

Steven Campbell, MD

Director, Urology Residency Training Program

Drogo K. Montague, MD

Associate Director,

Urology Residency Training Program

John C. Rabets, MD

Associate Director,

Urology Residency Training Program

A National Referral Center, An International Health Resource

Founded in 1921, Cleveland Clinic is a nonprofit,

multispecialty academic medical center that inte-

grates clinical and hospital care with research and

education. Today, 2,000 physicians and scientists

practice in 120 medical specialties and subspecial-

ties, annually recording about 3.7 million patient

visits and more than 79,000 surgeries.

Cleveland Clinic’s main campus on 180 acres

in Cleveland, Ohio, includes a 1,300-bed hospital,

an outpatient clinic, a research institute, specialty

institutes, and supporting labs and facilities.

Cleveland Clinic also operates 17 family health

centers, nine community hospitals, a children’s

hospital for rehabilitation and one affiliate hospital

in Ohio; a 150-bed hospital and clinic in Weston,

Fla.; a center for brain health in Las Vegas; and

health and wellness centers in West Palm Beach,

Fla., and Toronto, Canada. Cleveland Clinic Abu

Dhabi (United Arab Emirates), a multispecialty

care hospital and clinic, is scheduled to open

in late 2012.

The Lerner Research Institute is home to all labo-

ratory-based, translational and clinical biomedical

research at Cleveland Clinic. Within 650,000 total

square feet of research space, more than 1,200

scientists and support personnel collaborate with

clinical researchers to unravel the mysteries of dis-

ease. It is one of the leading NIH-funded research

institutes in the nation.

Our founding fathers’ dedication to training future

generations of physicians continues today. About

900 residents and fellows are involved in patient

care at Cleveland Clinic. In 2004, Cleveland

Clinic Lerner College of Medicine of Case Western

Reserve University opened. The first students in the

program graduated as physician-scientists in 2009.

In 2008, Cleveland Clinic was redesignated as

a Magnet® status hospital, the most sought-after

indicator of nursing excellence, by the American

Nurses Credentialing Center. Hospitals that achieve

Magnet status are recognized for providing the

highest standard of nursing care and excellence.

In 2007, Cleveland Clinic restructured its practice,

bundling all clinical specialties into integrated prac-

tice units called institutes. An institute combines all

the specialties surrounding a specific organ or dis-

ease system under a single roof. Each institute has

a single leader and focuses the energies of multiple

professionals onto the patient. From access and

communication to billing and point-of-care service,

institutes are improving the patient experience at

Cleveland Clinic.

And the quality of medical care at Cleveland Clinic

has been recognized repeatedly. Every year since

1990, U.S.News & World Report has named

Cleveland Clinic one of the nation’s best hospitals

in its “America’s Best Hospitals” survey. Since

2000, U.S. News has designated Cleveland Clinic’s

urology program as one of the top two urology

programs in the United States.John C. Rabets, MD

Associate Director,

Urology Residency Training Program

The Cleveland Clinic Glickman Urological & Kidney Institute’s urology program has

a professional staff of 75 physicians and scientists representing all subspecial-

ties of urology and composing the largest full-time urology faculty in the United

States.

Residents participate in all aspects of patient care in general and subspecialty

urology from outpatient evaluation in clinics to office surgical procedures to

inpatient and outpatient surgery to postoperative care. A large staff of physician

assistants and nurse practitioners is available to handle noneducational patient

responsibilities during the day.

In the fall of 2008, the Glickman Urological & Kidney Institute moved into the

newly built Glickman Tower. At 12 stories, the tower is the tallest building on

Cleveland Clinic’s main campus. Its 200,000 square feet contain 77 physician

offices, 16 technologically sophisticated procedure rooms, 12 outpatient procedure

rooms and 74 exam rooms. An auditorium is fully equipped with technology for

telemedicine and videoconferencing.

The 21-bed dialysis unit is designed with floor-to-ceiling windows offering scenic

views of the outdoors. The tower also features a chapel and meditation room. A

four-story grand hall features artwork, a café and an educational health resource

center for patients.

The Cleveland Clinic Glickman Urological & Kidney Institute

Institute Leadership

Eric Klein, MDChairman, Glickman Urological & Kidney Institute

Edmund Sabanegh, MDChairman, Department of Urology Vice Chairman, Glickman Urological & Kidney Institute

J. Stephen Jones, MD, FACSChairman, Department of Regional UrologyVice Chairman, Glickman Urological & Kidney Institute

Martin S. Schreiber, Jr., MDChairman, Department of Nephrology & Hypertension Vice Chairman, Glickman Urological & Kidney Institute

Cleveland Clinic is approved for five years of clinical training, with one year of general surgery and

four years of urology training. In addition, one year is spent developing skills in basic urological

research. Five residents are appointed each year. There is an emphasis on clinical and operative

urology, with residents pursuing a diversity of specialties within urology upon completion of the

training program. During the last 10 years, two-thirds of our residents have pursued competitive

fellowships, with half of all graduates going on to academic careers.

Residency Training Program

Graduate Level I (Year 1) 7 months general surgery 1 month general urology 1 month renal transplantation 1 month emergency medicine 1 month surgical intensive care 1 month nephrology

Graduate Level II (Year 2) 1 month urologic oncology 2 months endourology 2 months prosthetics/reconstructive urology 1 month pediatric urology 1 month laparoscopic urology 1 month female urology and voiding dysfunction 1 month infertility/outpatient urology 2 months inpatient consults

Graduate Level III (Year 3) 3 months urologic oncology 1 month endourology 1 month prosthetics/reconstructive urology 1 month renal transplantation 1 month pediatric urology 1 month laparoscopic urology 1 month female urology and voiding dysfunction 1 month infertility/outpatient urology 1 month inpatient consults

Research Resident (Year 4) Basic and translational urological research with no clinical responsibilities. Didactic research course throughout the year run by Daniel Shoskes, MD, and Matthew Simmons, MD, PhD, covering such areas as basic and advanced statistics, experimental design, clinical trial design, how to write a grant/abstract/paper, how to give presentations at meetings, and a basic science journal club.

Graduate Level IV (Year 5) 5 months urologic oncology 2 months renal transplantation 1 month pediatric urology 1 month laparoscopic urology 1 month female urology and voiding dysfunction 1 month infertility/outpatient urology

Graduate Level V (Year 6) Chief resident year with primarily operative, administrative and educational responsibilities as well as supervision of inpatient services.

TeachingConferences

-ChiefResidents’Conference– Weekly

-DidacticConference – Biweekly

-MorbidityandMortalityConference – Monthly

-OncologyMultidisciplinaryConference – Monthly

-PatientManagementConference – Weekly

-JournalClub – Monthly

From the first day after internship, residents are entrusted with

independently running their own inpatient services tailored to a sub-

specialty of urology. Residents work directly with faculty in a precep-

tor model to learn management of urologic disorders in an inpatient

setting and outpatient clinics. Residents at each level participate in

the operating room three to four days per week, with emphasis on

endourology and male genital surgery at junior levels and on open and

laparoscopic oncologic and reconstructive surgery at senior levels.

Chief residents focus on refining operating skills in preparation for

fellowship and practice, and shoulder administrative and educational

responsibilities for the residency program.

On-call duties require GL2 residents to spend three nights per month

and GL3 residents to spend two to three weeknights per month in

the hospital. GL4 research residents are free from all clinical responsi-

bilities. GL5 residents have one in-house call per month. The four chief

residents rotate weekly as the supervising/backup house officer.

Resident Responsibilities

Renalcancer – The majority of the radical

nephrectomies performed at Cleveland Clinic are

performed laparoscopically. A number of open

radical nephrectomies with vena caval thrombec-

tomy are performed each year in conjunction

with cardiothoracic surgery. Our institute has the

largest experience of partial nephrectomy in the

world. The scope of nephron-sparing surgery is

further expanded by our extensive experience in

laparoscopic and percutaneous cryoablation of

renal tumors.

Prostatecancer– Our prostate cancer training

experience is unique because it offers expertise

in all forms of therapy for men with localized

disease — open, laparoscopic, and robotic radical

prostatectomy; focal, subtotal, and whole gland

cryotherapy; brachytherapy; and multidsiciplinary

approaches including neoadjuvant systemic therapy

in conjunction with surgery for locally advanced

disease. The program evaluates and treats more

than 1,000 new patients annually and performs

600 radical prostatectomies per year. During the

outpatient rotation, residents become facile at

transrectal ultrasound-guided biopsy.

Bladdercancer– Our physicians perform more

than 600 transurethral resections of the bladder

each year. Cleveland Clinic is a leader in the field of

robotic and laparoscopic radical cystectomy, having

performed more than 200 such cases as of 2009.

Residents also become adept at the full range

of options for urinary diversion, with an emphasis

on orthotopic neobladders.

Testiscancer– Residents are educated in the

management of testis cancer on a multidisciplinary

level. An average of 20 to 30 retroperitoneal

lymph node dissection procedures are performed

each year.

Adrenalsurgery– The majority of the adrenal-

ectomies performed here are performed laparo-

scopically. Residents are trained in the surgical and

medical management of adrenal masses manifest-

ing as Cushing’s syndrome, pheochromocytoma,

hyperaldosteronism and adrenal cortical carcinoma.

Scope of Urology ServicesThe Cleveland Clinic Glickman Urological & Kidney Institute provides a wide range of adult and pediatric

urological services. About 16 percent of our patients come from outside of Ohio, and patients from many

countries throughout the world are frequently seen throughout Cleveland Clinic. In addition to providing gen-

eral adult and pediatric urological services, the institute also provides many highly specialized tertiary care

services, described in more detail in the following pages.

Urologic Oncology

Laparoscopic and Robotic SurgeryAs a high-volume center for laparoscopic urologic surgery, we have

continued to remain on the forefront in developing new techniques

and expanding the scope of minimally invasive surgery. Residents

participate in laparoscopic adrenalectomy, partial nephrectomy,

radical nephrectomy, renal cryoablation, radical cystectomy,

prostatectomy, pyeloplasty, ileal ureter transposition, orchidopexy,

sacrocolpopexy and ureterolysis. Robotic surgery is being utilized

for prostatectomy, cystectomy and pyeloplasty procedures.

Renal Transplantation

Since the first kidney transplant in 1963 at Cleveland Clinic,

the institute has performed more than 3,500 renal transplants.

Residents spend four months over three different years learning

technique and principles of renal transplantation, a service run

entirely by staff of the Glickman Urological & Kidney Institute.

During this rotation, residents perfect skills in vascular anasto-

mosis, ureteroneocystotomy, cadaveric organ procurement, living

donor open and laparoscopic nephrectomy, pancreas transplanta-

tion, immunosuppressive protocols, and evaluation of patients

with end-stage renal disease.

Prosthetics and ReconstructionGlickman Urological & Kidney Institute faculty possess

special expertise in complex urethral reconstruction for stricture

disease. Using plastic surgery principles, about 80 such proce-

dures per year are performed using a combination of flaps, buccal

mucosal grafts and simpler anastomotic procedures. Additionally,

complex fistula repairs are undertaken, often in conjunction with

the Department of Colorectal Surgery. A high volume of patients

with Peyronie’s disease or congenital penile curvature are seen for

tunical plication procedures. On average, 200 prosthetic surgeries,

including inflatable penile prostheses, artificial urinary sphincters

and revisions, are done each year. Residents are educated in

the nonsurgical management of erectile dysfunction with faculty

possessing expertise in this field.

Voiding Dysfunction and Female UrologyMore than 300 vaginal sling procedures are performed each year

at Cleveland Clinic. More than 2,000 urodynamics procedures

are performed each year in our dedicated urodynamics facility by

specially trained nurses. Residents and faculty interpret studies in

the management of patients with incontinence, neuro-urological

disorders, or other types of voiding dysfunction. A number of pa-

tients with pelvic organ prolapse are seen, and about 250 surgical

procedures, including laparoscopic sacrocolpopexy, are performed

each year for repair of vaginal prolapse. Interstim neurostimulator

devices for refractory overactive bladder or chronic pelvic pain are

being used in increasing numbers.

Endourology and Stone DiseaseResidents participate at both the main campus and outpatient

surgery centers in the surgical management of patients with

renal calculus disease. On average, 900 procedures for renal

calculi are performed each year, including complex procedures

on patients with solitary kidneys, morbid obesity or anatomically

displaced kidneys. The Glickman Urological & Kidney Institute also

utilizes laparoscopic and open pyeloplasty, with about 60 adult

and pediatric patients treated yearly for ureteropelvic junction

(UPJ) obstruction. Additional patients are treated endoscopically

with endopyelotomy for UPJ obstruction. Residents are trained in

all aspects of stone treatment, including gaining percutaneous

access in the operating room.

Benign Prostatic HyperplasiaAt the junior level, residents become well-versed in performing

photoselective vaporization of the prostate procedures with the

GreenLightTM laser for BPH as well as the more traditional

transurethral resection of the prostate using the Gyrus instrument

with saline irrigation.

Pediatric UrologyResidents work one-on-one with our pediatric urologists in

outpatient management of urological issues and are well-trained

in performing such procedures as hypospadias repair, open and

laparoscopic pyeloplasty, open and laparoscopic orchidopexy,

surgical and endoscopic management of vesicoureteral reflux,

surgical management of Wilms’ tumor and testis cancer, hernia/

hydrocele repair, and circumcision.

Male InfertilityResidents are trained in the thorough evaluation of men presenting

with infertility and instructed in surgical techniques for varicocele

ligation, microsurgical vasovasostomy and epididymo-vasostomy,

and testicular sperm aspiration. The institute also houses a highly

sophisticated andrology laboratory and active Center for Advanced

Research in Human Reproduction, Infertility and Sexual Function.

During internship, each resident takes a one-week dedicated

microsurgery course with instruction on animal models.

All urology residents are encouraged to take advan-

tage of the opportunity to perform both clinical and

basic research studies during their training. Residents

perform such projects under the close supervision

of one or more members of the attending staff,

who assist in preparing manuscripts for publication.

Residents also are encouraged to submit these papers

for presentation at regional or national urology meet-

ings. Residents presenting at national conferences are

provided funds for travel during all years.

The Lerner Research Institute, a complex of laborato-

ries, classrooms, libraries and multimedia centers,

has been designed to provide a dynamic center for

Cleveland Clinic’s research and education activi-

ties. The Glickman Urological & Kidney Institute has

several basic research laboratories where residents

develop their scientific skills during the 12 months

of the fourth year. These include:

TheNovickCenterforClinicalandTranslational

Research facilitates interaction between researchers

and clinicians across the departments of nephrology

and urology. It also seeks to promote clinical and

translational research and to help assure compliance

with all federal and institutional regulations. The cen-

ter allows for the necessary and efficient pooling

of resources within the Glickman Urological & Kidney

Institute. Staff members work closely with the

Lerner Research Institute to be sure regulations and

mandates are followed and to review every existing

and future clinical study for soundness, budget and

required resources.

Theurologiconcologybasicresearchlaboratories

are molecular biology facilities devoted to the im-

munobiology of renal cell carcinoma. Ongoing studies

include impaired activation of NFkB in T cells from

patients with renal cell carcinoma, T cell-induced

apoptosis in renal cell carcinoma, immunological

effects of sunitinib, and chemokine gene expression

in renal cell carcinomas.

Basic research in prostate cancer includes studies

on XMRV and viral causes of prostate cancer as well

as the role of PSA and prostate-specific membrane

antigen to guide targeted therapies in prostate cancer.

There are also ongoing studies for bladder cancer

investigating intravesical immune-modulating gene

therapy in an orthotopic, noninvasive bladder

cancer model.

Thetransplantimmunologylaboratory is focused

on defining T cell-mediated inflammatory responses

following organ transplantation. The understanding of

mechanisms by which T cells are induced to mediate

inflammation is essential to the design of practical

clinical strategies to inhibit the priming of alloreactive

T cells and to maintain allograft acceptance in

transplant recipients.

TheCenterforAdvancedResearchinHuman

Reproduction,InfertilityandSexualFunction is

performing extensive studies on reactive oxygen spe-

cies formation in human sperm and their role in male

infertility. Additional areas of investigation include

assessment of human sperm function after cryo-

preservation and methods of improving post-thaw

semen quality in cancer patients.

Theneurology/urologylaboratoryandCenterfor

FemalePelvicMedicine are recognized nationally as

an elite group focused on characterizing the regulatory

mechanisms of benign bladder conditions and pelvic

floor injury and repair. Areas of investigation include

biomechanical properties of the bladder and pelvic

floor, diabetic cystopathy, inflammatory diseases of

the bladder, and stem cell homing after pelvic injury.

Theminimallyinvasiveandroboticresearch

laboratoryis focused on identifying new minimally

invasive and noninvasive treatments for urologic

disease and transferring these technologies to the

operating room. Research areas include intraopera-

tive imaging techniques, transcutaneous CT- and

ultrasound-guided surgery, and development of new

laparoscopic technologies.

Research

Arts and Entertainment

University Circle, Cleveland’s cultural center, has

one of the greatest concentrations of museums and

cultural activities in the country. Highlights of arts

and entertainment in Cleveland include:

ClevelandMuseumofArt

ClevelandOrchestra

BlossomMusicCenter,QuickenLoansArena,

WolsteinCenterandClevelandBrownsStadium

hostingbig-namerock,pop,countryandjazz

performers

ClevelandPlayHouseandPlayhouse

Square—hometotheClevelandOpera,

GreatLakesTheaterFestivalandtouring

Broadwayshows

RockandRollHallofFameandMuseum

GreatLakesScienceMuseum,withthe

320-seatClevelandClinicOMNIMAXTheater

Little Italy

Many around the city enjoy the atmosphere of

Cleveland’s Little Italy, located five minutes from

Cleveland Clinic’s main campus. This unique section

of town features restaurants, shops, art galleries

and more.

Nightlife

For Cleveland nightlife, visit the Warehouse District,

where former warehouses have been converted into

modern apartments and office buildings, with elegant

and trendy restaurants, nightclubs and bars at street

level. Or visit the brick-lined East Fourth Street

district, with gourmet dining and jazz venues, a

comedy club and martini bars.

Recreation and Sports

The Cleveland Metroparks Zoo and Cedar Point

Amusement Park offer summer fun. Lake Erie pro-

vides entertainment for sailing enthusiasts, boaters,

swimmers and fishermen. The Cleveland Metroparks’

16 nature reserves encircling the city, along with the

Cuyahoga Valley National Park, offer running, hiking

and biking trails and many outdoor activities. Winter

in Cleveland unveils cross-country and downhill skiing,

tobogganing and snowmobiling. Major league sports

are represented by the Cleveland Browns, Cleveland

Indians and Cleveland Cavaliers.

About Cleveland The same vitality that charges Cleveland

Clinic extends to almost every aspect of

life in Cleveland.

For more information about the Urology Residency Training Program, contact:

Mary Ellen Nolder Urology Residency Coordinator / Q10 Cleveland Clinic 9500 Euclid Avenue Cleveland, OH 44195

Office: 216.445.7242

Fax: 216.445.2267

Email: nolderm@ccf.org

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